Cao Z Y, Wu W, Hou L K, Zhang W, Gao C X, Wu C Y, Zhang L P
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
Zhonghua Bing Li Xue Za Zhi. 2018 Dec 8;47(12):910-914. doi: 10.3760/cma.j.issn.0529-5807.2018.12.003.
To compare droplet digital PCR (ddPCR) and Super-amplification refractory mutation system (ARMS) in the detection of T790M mutation of epidermal growth factor receptor (EGFR) in the plasma of non-small cell lung cancer patients who had developed resistance to EGFR tyrosine kinase inhibitor (TKI) , and to investigate the clinical application of ddPCR. Plasma samples were collected from non-small cell lung cancer patients who had acquired EGFR-TKI resistance at Shanghai Pulmonary Hospital, Tongji University, from May 2017 to November 2017. Extracted ctDNA was analyzed by ddPCR and Super-ARMS to evaluate the T790M mutation status of EGFR gene. A total of 37 patients with activating EGFR mutation that acquired resistance to EGFR-TKI were selected in the study, including 17 male and 20 female with a median age of 64 years (range 40-83 years). Before TKI treatment, all the patients harbored EGFR inhibitor sensitive mutations but without T790M mutation. After acquiring resistance to EGFR-TKI treatment, the T790M mutation rate detectable by ddPCR was 45.9% (17/37). In contrast, the mutation rate of T790M detectable by Super-ARMS was 35.1% (13/37, <0.05). For the 13 positive cases detected by Super-ARMS (ΔCt<8), they were all positive by ddPCR assay; Among the 10 negative cases detected by Super-ARMS (ΔCt≥8), there were 3 cases positive by ddPCR assay. For patients without ΔCt by Super-ARMS assay, there was one weak positive case detectable by ddPCR assay. Among 17 EGFR T790M positive patients, 9 received EGFR inhibitor Osimertinib treatment, and 7 of them had good therapeutic response after the treatment. While a significant correlation between the two methods is shown. ddPCR is more sensitive than Super-ARMS in the detection of EGFR T790M mutation, indicating that it is a better method in guiding target drug therapy of non-small cell lung cancer patients after acquiring the resistance to EGFR-TKI.
比较液滴数字PCR(ddPCR)和超级扩增阻滞突变系统(ARMS)检测对表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)耐药的非小细胞肺癌患者血浆中EGFR基因T790M突变的情况,并探讨ddPCR的临床应用。于2017年5月至2017年11月在同济大学附属上海市肺科医院收集对EGFR-TKI耐药的非小细胞肺癌患者的血浆样本。提取的循环肿瘤DNA(ctDNA)通过ddPCR和超级ARMS进行分析,以评估EGFR基因的T790M突变状态。本研究共纳入37例对EGFR-TKI获得性耐药的EGFR激活突变患者,其中男性17例,女性20例,中位年龄64岁(范围40-83岁)。在TKI治疗前,所有患者均携带EGFR抑制剂敏感突变,但无T790M突变。在对EGFR-TKI治疗获得性耐药后,ddPCR检测到的T790M突变率为45.9%(17/37)。相比之下,超级ARMS检测到的T790M突变率为35.1%(13/37,P<0.05)。对于超级ARMS检测到的13例阳性病例(ΔCt<8),ddPCR检测均为阳性;在超级ARMS检测到的10例阴性病例(ΔCt≥8)中,ddPCR检测有3例阳性。对于超级ARMS检测无ΔCt的患者,ddPCR检测有1例弱阳性病例。在17例EGFR T790M阳性患者中,9例接受了EGFR抑制剂奥希替尼治疗,其中7例治疗后有良好的治疗反应。两种方法显示出显著相关性。ddPCR在检测EGFR T790M突变方面比超级ARMS更敏感,表明其在指导对EGFR-TKI耐药后的非小细胞肺癌患者的靶向药物治疗方面是一种更好的方法。